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Converted laparoscopic colorectal surgery

A meta-analysis

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  • 121 Citations

Abstract

Background

Conversion rates following laparoscopic colorectal surgery vary widely between studies, and the outcome of converted patients remains controversial.

Methods

A comprehensive search of the English-language literature was updated until May 1999.

Results

Twenty-eight studies on 3232 patients were considered for analysis. The overall conversion rate was 15.38%. Seventy nine percent of the studies did not include a definition for conversion; in these studies, the conversion rate was significantly lower than in the series where a specific definition was considered (13.7% vs 18.9%, chi-square test, p<0.001). Converted patients had a prolonged hospital stay (11.38 vs 7.41 days) and operative time (209 vs 189 min) in comparison with laparoscopically completed patients (95% confidence interval (CI), 1.70–4.00 and 35.90–37.10, respectively). The factors associated with an increased rate for conversion were left colectomy (Odds Ratio [OR]=1.061), anterior resection of the rectum (OR=1.088), diverticulitis (OR=1.302), and cancer (OR=2.944) (for each parameter, Wald chi-square value, p<0.001).

Conclusions

In nonrandomized studies, the rate of laparoscopically completed colorectal resections is close to 85%. Because converted patients have a distinct outcome, a clear definition of conversion is required to compare the results of randomized trials. Such trials should also consider a 20% rate of conversion when estimating the sample size for the desired power level. It is likely that converted patients will have a significant impact on the results of future clinical research in laparoscopic colorectal surgery.

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References

  1. 1.

    Agachan F, Joo JS, Weiss EG, Wexner SD (1996) Intraoperative laparoscopic complications: are we getting better? Dis Colon Rectum 39: S14-S19

  2. 2.

    Begos DG, Arsenault J, Ballantyne GH (1996) Laparoscopic colon and rectal surgery at a VA hospital: analysis of the first 50 cases. Surg Endosc 10: 1050–1056 DOI: 10.1007/s004649900238

  3. 3.

    Bennett CL, Stryker SJ, Ferreira MR, Adams J, Beart RW (1997) The learning curve for laparoscopic colorectal surgery. Arch Surg 132: 41–44

  4. 4.

    Bokey EL, Moore JW, Keating JP, et al. Laparoscopic resection of the colon and rectum for cancer. Br J Surg 84: 822–825

  5. 5.

    Boulez J, Espalieu P, Fontaumard E, Meeus P (1997) Laparoscopic colo-rectal surgery: analysis of 113 cases. Hepatogastroenterology 44: 40–44

  6. 6.

    Cappelleri JC, Ioannidis JPA, Schmid CH, et al. Large trials vs meta-analysis of smaller trials: How do their results compare? JAMA 276: 1332–1338

  7. 7.

    Delgado F, Bolufer JM, Grau E, et al. Laparoscopic colorectal cancer resection: initial follow-up results. Surg Laparosc Endosc 9: 91–98

  8. 8.

    Eijsbouts QA, Cuesta MA, de Brauw LM, Sietses C (1997) Elective laparoscopic-assisted sigmoid resection for diverticular disease. Surg Endosc 11: 750–753 DOI: 10.1007/s004649900442

  9. 9.

    Falk PM, Beart RW Jr, Wexner SD, et al. Laparoscopic colectomy: a critical appraisal. Dis colon Rectum 36: 28–34

  10. 10.

    Fielding GA, Lumley J, Nathanson L, et al. Laparoscopic colectomy. Surg Endosc 11: 745–749 DOI: 10.1007/s004649900441

  11. 11.

    Fleshman JW, Nelson H, Peters WR, et al. Early results of laparoscopic surgery for colorectal cancer: retrospective analysis of 372 patients treated by Clinical Outcomes of Surgical Therapy Study Group. Dis Colon Rectum 39: S53–S58

  12. 12.

    Franklin ME, Rosenthal D, Abrego-Medina D, Dorman JP, et al. Prospective comparison of open vs laparoscopic colon surgery for carcinoma: five-year results. Dis Colon Rectum 39: S35–S46

  13. 13.

    Gellman L, Salky B, Edye M (1996) Laparoscopic-assisted colectomy. Surg Endosc 10: 1041–1044 DOI: 10.1007/s004649900236

  14. 14.

    Hoffman GC, Baker JW, Fitchett CW, Vansant JH (1994) Laparoscopic-assisted colectomy: initial experience. Ann Surg 219: 732–743

  15. 15.

    Huscher C, Silecchia G, Croce E, et al. Laparoscopic colorectal resection. Surg Endosc 10: 875–879 DOI: 10. 1007/s004649900187

  16. 16.

    Khalili TM, Fleshner PR, Hiatt JR, et al. Colorectal cancer: comparison of laparoscopic with open approaches. Dis Colon Rectum 41: 832–838

  17. 17.

    Kohler L, Rixen D, Troidl H (1998) Laparoscopic colorectal resection for diverticulitis. Int J Colorect Dis 13: 43–47: DOI: 10.1007/s003840050130

  18. 18.

    Lacy AM, Garcia-Valdecasas JC, Pique JM, et al. Short-term outcome analysis of a randomized study comparing laparoscopic vs open colectomy for colon cancer. Surg Endosc 9: 1101–1105

  19. 19.

    Laird NM, Mosteller F (1990) Some statistical methods for combining experimental results. Int J Tech Ass Health Care 6: 5–30

  20. 20.

    Larach SW, Patankar SK, Ferrara A, et al. Complications of laparoscopic colorectal surgery: analysis and comparison of early vs latter experience. Dis Colon Rectum 40: 592–596

  21. 21.

    Leung KL, Yiu RY, Lai PB, et al. Laparoscopic-assisted resection for colorectal carcinoma: five-year audit. Dis Colon Rectum 42: 327–332

  22. 22.

    Monson JRT, Darzi A, Declan Carey P, Guillou PJ (1992) Prospective evaluation of laparocopic-assisted colectomy in an unselected group of patients. Lancet 340: 831–833

  23. 23.

    Pandya S, Murray JJ, Coller JA, Rusin LC (1999) Laparoscopic colectomy: indications for conversion to laparotomy. Arch Surg 134: 471–475

  24. 24.

    Poulin EC, Mamazza J, Schlachta CM, Gregoire R, Roy N (1999) Laparoscopic resection does not adversely affect early survival curves in patients undergoing surgery for colorectal adenocarcinoma. Ann Surg 229: 487–492 DOI: 10.1097/00000658-199904000-00006

  25. 25.

    Psaila J, Bulley SH, Ewings P, Sheffield JP, Kennedy RH (1998) Outcome following laparoscopic resection for colorectal cancer. Br J Surg 85: 662–664

  26. 26.

    Puente I, Sosa JL, Sleeman D, et al. Laparoscopic-assisted colorectal surgery. J Laparoendosc Surg 4: 1–6

  27. 27.

    Ramos JM, Beart RW Jr, Goes R, Ortega AE, Schlinkert RT (1995) Role of laparoscopy in colorectal surgery. Dis Colon Rectum 38: 494–501

  28. 28.

    Regadas FS, Rodrigues LV, Nicodemo AM, et al. Complications in laparoscopic colorectal resection: main types and prevention. Surg Laparosc Endosc 8: 189–192

  29. 29.

    Sackier JM (1998) Laparoscopic colon and rectal resection. In: Corman NM (ed) Colon and rectal surgery. 4th ed. Lippincott, Philadelphia, pp

  30. 30.

    Schwandner O, Schiedeck TH, Bruch H (1999) The role of conversion in laparoscopic colorectal surgery: do predictive factors exist? Surg Endosc 13: 151–156 DOI: 10.1007/s004649900927

  31. 31.

    Sheldon TA (1999) Systematic reviews and meta-analyses: the value for surgery. Br J Surg 86: 977–978 DOI: 10. 1046/j.1365-2168.1999.01235.x

  32. 32.

    Sher ME, Agachan F, Bortul M, et al. Laparoscopic surgery for diverticulitis. Surg Endosc 11: 264–267 DOI: 10.1007/s004649900340

  33. 33.

    Slim K, Pezet D, Riff Y, Clark E, Chipponi J (1995). High morbidity rate after converted laparoscopic colorectal surgery. Br J Surg 82: 1406–1408

  34. 34.

    Tucker JG, Ambroze WL, Orangio GR, et al. Laparoscopically assisted bowel surgery: analysis of 114 cases. Surg Endosc 9: 297–300

  35. 35.

    Zucker KA, Pitcher DE, Martin DT, Ford RS (1994) Laparoscopicassisted colon resection. Surg Endosc 8: 12–18

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Author information

Correspondence to S. Wexner.

Additional information

Online publication: 11 May 2001

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Gervaz, P., Pikarsky, A., Utech, M. et al. Converted laparoscopic colorectal surgery. Surg Endosc 15, 827–832 (2001). https://doi.org/10.1007/s004640080062

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Key words

  • Laparoscopy
  • Colon
  • Rectum
  • Metanalysis